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General NPI Number Information
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NPI Number | 1801333992
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Entity Type | Organization
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Legal Business Name | US NAVY
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Dates
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Enumeration Date | 01/26/2017
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Last Update Date | 01/26/2017
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Provider Practice Location Address
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Address Line | 1752 TRELLIS WAY
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City | CHULA VISTA
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State | CA
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Zip | 91915
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Country | US
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Telephone | 224-381-8749
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Fax |
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Provider Business Mailing Address
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Address Line | 1752 TRELLIS WAY
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City | CHULA VISTA
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State | CA
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Zip | 91915
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Country | US
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Telephone | 224-381-8749
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Fax |
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Authorized Official
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Title or Position | RDH
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Name | MS. MIRA LEE
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Credential |
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Telephone | 224-381-8749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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